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Aciclovir for Ramsay Hunt syndrome

Evidence Summaries

Level of Evidence = D

There is no direct evidence that aciclovir has a beneficial effect on outcomes in Ramsay Hunt syndrome (herpes zoster oticus, HZO, associated with acute facial paralysis), although the use of aciclovir in patients with HZ in other parts of the body suggest that they have a role also in HZO.

A Cochrane review 1 included 1 low-quality study with a total of 15 subjects. All participants received intravenous corticosteroids (methylprednisolone 20 mg/8 hours for 10 days). Seven participants only received this treatment (control group) whilst eight (the treatment group) received in addition intravenous acyclovir (10 mg/kg/8h for 10 days). No statistically significant difference between the two groups was found.

Comment: The quality of evidence is downgraded by imprecise results (very few patients and wide confidence intervals) and by study quality (lack of blinding).